Thursday, 29 January 2009

Conscience

Mother Theresa (Agnesë Gonxhe Bojaxhiu) was asked her views on what was charity. Her answer was that charity was the act of giving, and giving so much that it hurt. Anything less, she said, wasn't charity, it was justice.

This stirs ones thoughts. If we've spare cash, spare time, spare space, and we gift it to others, Mother Theresa would see that as just (and simply what should happen) rather than being an act of charity. It's only when it costs us something, when the consequence of what we're giving away is felt by us, that this truly can be seen as a charitable act.

I've been seeing a lady, let's call her Florence, who's been referred to me through not coping. Her husband died, suddenly. It wasn't gruesome, he died of a heart attack after they'd returned from the shops. Florence still regrets to this day that she sought some unsalted butter and they drove and argued about parking. She had a large house but had to sell it and move to a more modest bungalow.

Her daughter hasn't seen her for a couple decades, but returned from abroad for the funeral and to spend some time with her mother. The daughter's concerned Florence is, "loosing it" and, "not coping" which generated the referral. Her GP saw Florence and felt she was actually doing pretty well. The daughter insisted she, "wasn't right." Her GP spoke with me and made it quite clear who perceived there to be a problem and who's agenda needed to be addressed.

I saw Florence with a nursing colleague and we soon got the measure of what was going on. Florence was managing well. Her mood was generally bright, she had spells of low mood and despondent feelings, she had brief moments of bitterly intense tears and sorrow. But most of the time she was content and pretty cheerful. She'd described having what amounts to passive suicidal ideation, in the past, when she'd wished to go to sleep and not wake up, but didn't have such thoughts or feelings now (and never had a desire or plan to hurt herself).

She was sleeping pretty well (but not quite used to sleeping alone) with no insomnia. She was eating well and still cooked for herself, and her daughter whilst she was visiting. She visited friends, attended church, managed her shopping.

Mental state examination was unremarkable. Sometimes her concentration wasn't perfect (as she reflected back on what we'd just been talking about) but her MMSE was normal and cognitive testing was fine.

A death, a lot of changes (including selling a house), but she was coping. All well and good.

We then turned to Florence's daughter and asked her how she felt things were. "Mum's lost it, she's getting really confused, she's giving everything away to strangers!"

Florence knew what she owned. She told us how much money she had, where she had it saved, how much went in to which accounts each month, what her new house was worth, everything. She has significant savings. She explained what she thought was important to her, then explained which charities championed these, and what her local church did. She's never given money to random strangers or people asking opportunistically, she said that made her uncomfortable and so she just politely declines and leaves it at that. All emminently sensible. She spoke about her childhood (which was happy) and life as a young adult (which wasn't) then the life shared with her husband (which was mostly happy) and now time spent with friends. She thinks of her life and of how she's lived it and of how she can help others through donations.

Her daughter can't see why she wants to spend money so some strangers somewhere in Africa get a 20 foot section of pipe as part of a clean water programme. Or why she's paid to send people a goat. Or why she's paid for a tree to be planted in Scotland. Or why she gives up her time to clean the church once a week when, "The ladies half her age should be doing that!"

Another lady. Let's call her Rosemary. Rosemary is now in a 24 hour care home. Rosemary knows this, because she's got a good memory. She could tell me the name of the young lass who brought me a cup of coffee, tell me about what that carer had been doing at the weekend and how she'd been so hung over on her Saturday shift, who she'd been out with and what they'd been up to. The carer had the good sense to blush. It was all true. But her propensity for spilling the beans, inappropriately, on someone else's social life wasn't why I'd been asked to see her originally. She'd started giving money away, randomaly, to anyone. She changed her energy provider 3 times in a little over a month. She'd given away all her savings without appreciating who was getting her money or why. With strangers she'd also become rather, erm, overly amorous. Even supervised and supported in care homes she'd been found in bed with gentlemen (who all had dementia). Their wives were less than impressed. Rosemary's brain was scanned. Rosemary has profound frontal lobe damage, driving her impulsive and disinhibited and carefree behaviour.

Florence does not. Florence is normal. She simply has a well developed social conscience. With dismay, I fear it's through her inheritance dwindling that means it's not a formulation her daughter was keen to accept.

It makes me glad to know that a doctor such as yourself is working in the nhs, I've seen a couple of shocking ones during my experiences of the mental health system. I've just started blogging so am joining you all on this journey.

Why Lake Cocytus?

Dante's "Inferno" takes us on a journey through to the deepest layer of Hell, passing down through layers of fire. Within this Ninth Layer there is no flame, there is a lake of ice. Imprisoned within this are the those of greatest evil, those of greatest betrayal. Rather a puzzle to me, this one. Is it a terrible place, manifesting evil incarnate? Or is Lake Cocytus a good thing, containing the world's greatest evils?

Good or evil this place, this Lake Cocytus, is my space to entomb the thoughts and musings best interred in ice.

"Because love is not sex or a shared faith, or the 'joint maintenance of a household and the upbringing of children'."
- Sergei Lukyanenko

"Look at that. Look at that. "Accident Blackspot"? These aren't accidents. They're throwing themselves into the road gladly. Throwing themselves into the road to escape all this hideousness."
- Withnail & I

"We know what happens to people who stay in the middle of the road. They get run down."
- Aneurin Bevan